Who Pays for Palliative Care? All Options Explained

Palliative care in a nursing home is funded through the same routes as standard nursing care: NHS Continuing Healthcare (fully funded if there is a primary health need), NHS-Funded Nursing Care (a £267.78 per week contribution), council means-tested funding, or self-funding. Hospice care is always free. The key question is whether the person qualifies for CHC — and fast-track CHC is available when prognosis is under 12 months, which means many families paying privately do not need to be.

This guide compares who pays for palliative care in every setting — hospice, home, nursing home, and care home — so you can see all the options in one place.

This guide covers England only. Scotland, Wales, and Northern Ireland have different care funding systems.

Last updated: March 2026.

Quick Answer: Palliative Care Funding by Setting

The single most important thing to take from this table: if someone is approaching end of life and you are paying for care, ask about fast-track CHC. It can make the care free within 48 hours.

Option 1: Hospice Care (Always Free)

Hospice care is free. It is funded through a combination of NHS contracts and charitable donations. There is no means test, no financial assessment, and no bill at the end. This applies to all hospice services.

Inpatient hospice

A stay in a hospice building, typically for the final days or weeks of life. Inpatient hospice provides intensive symptom management, emotional support for the patient and family, and round-the-clock specialist nursing.

How to access: Ask the GP or hospital consultant for a referral. Referrals can also be made by district nurses, specialist nurses, or the person themselves.

Availability: The biggest limitation of hospice care is bed availability. England has around 220 hospices, and demand regularly exceeds capacity. Not everyone who would benefit from inpatient hospice care can access it at the time they need it.

Duration: Inpatient hospice is not long-term care. Most stays are days to weeks. Some hospices offer "step-down" care, where someone is stabilised and then returns home or to a care home with ongoing hospice-at-home support.

Hospice-at-home

Specialist nurses visit the person at home to provide palliative care, pain management, and emotional support. Marie Curie nurses offer a similar service, providing overnight nursing so family carers can rest.

How to access: GP referral to the local hospice-at-home team. Marie Curie can be contacted directly or through the GP.

What it covers: Hospice-at-home does not replace full-time care. It provides specialist visits — typically a few hours per day or overnight — alongside whatever other care is in place. If round-the-clock palliative care at home is needed, hospice-at-home may not be sufficient on its own.

Day hospice

Regular visits (typically once or twice a week) to a hospice for symptom management, therapy, social activities, and support. This is for people who are still well enough to travel and who benefit from the structured environment and specialist input.

Option 2: Palliative Care at Home

For many families, the priority is for their parent to die at home. This is achievable, but the care arrangements and funding depend on the route you take.

Fast-track CHC: the option most families miss

If someone has a rapidly deteriorating condition and a prognosis of weeks to months, they can be assessed for fast-track NHS Continuing Healthcare. If approved, the NHS pays for all care — including live-in carers, specialist nurses, equipment, and medication — in any setting, including at home.

Fast-track CHC can be arranged within 48 hours. A clinician — GP, hospital consultant, or specialist nurse — completes a fast-track pathway tool. The decision is made by the local Integrated Care Board (ICB), and the bar for approval is lower than for standard CHC because the urgency is recognised.

Why this matters: Many families at the end-of-life stage are paying privately for care at home — £1,200-£1,700 per week — when the NHS would fund it through fast-track CHC. The GP simply needs to be asked. If they are not aware of the process, the hospital discharge team or district nurse can initiate it.

Worked Scenario: Unlocking Fast-Track CHC

To understand the financial and emotional impact of this funding, consider the following situation.

The Situation: Eleanor (81) has end-stage heart failure. She has just been discharged from the hospital. Her wish is to die at home. Her daughter, Sarah, takes time off work to care for her but quickly realises she cannot manage Eleanor's severe breathlessness and pain overnight.

Without Fast-Track CHC: Sarah contacts a private home care agency. They quote £1,500/week for waking night care and daily support visits. Eleanor has £30,000 in savings. The family starts paying privately, watching the savings drain by £6,000 a month, adding acute financial stress to their grief.

With Fast-Track CHC: Before discharge, or via the GP immediately after, Sarah asks for a Fast-Track CHC assessment, stating: "My mother is entering the terminal phase of her illness and is deteriorating rapidly. She requires continuous symptom management."

• The GP completes the Fast-Track Pathway Tool.
• Within 48 hours, the local Integrated Care Board (ICB) approves the funding.
• The NHS immediately commissions and pays for the same £1,500/week care package, plus a specialist hospital bed and pressure-relieving mattress for the home.
• The Result: Eleanor gets the exact same care, but it is 100% free. Her savings are untouched, and Sarah can focus entirely on being a daughter, not a stressed project manager.

For a full guide to CHC, including how to appeal a refusal, see our guides to CHC eligibility and how to appeal a CHC decision.

Standard CHC

If the condition is serious but the prognosis is longer than "rapidly deteriorating," standard CHC is assessed through a fuller process. This takes up to 28 days and involves a multidisciplinary team assessment. If approved, all care is funded by the NHS.

Council-funded home care

If CHC is not granted, the standard council means test applies. If the person's assets are below £23,250, the council contributes to care costs. The property is not counted while the person lives in it.

Self-funded private care

If neither CHC nor council funding applies, you pay for palliative home care privately.

• Visiting palliative care: £145-£220 per day for several hours of specialist nursing and personal care
• Live-in palliative care: £1,400-£1,700 per week

These costs are the same as standard home care costs and live-in care costs, though specialist palliative carers may command a premium.

A Critical Edge (The MSIF Benchmark): If you are forced to self-fund palliative care at home, the costs can escalate to £1,700+ per week very quickly. Before draining your family's savings, you must check what a specialist palliative care bed in a nursing home costs in your area. RightCareHome publishes the Market Sustainability and Improvement Fund (MSIF) data—the exact rates local councils pay for these beds. If your council pays £1,100/week for 24/7 nursing care in a fully equipped care home, paying £1,700/week for home care is a massive financial premium. Knowing the true local benchmark helps you decide when staying at home stops being financially sustainable.

For a detailed guide to arranging end of life care at home, including what to expect and practical arrangements, see our full guide.

Option 3: Nursing Home with Palliative Expertise

Some people reach end of life while already in a nursing home. Others need to move into one because their palliative care needs exceed what can be safely provided at home.

Funding a nursing home at end of life

The funding rules are the same as for any nursing home stay:

NHS Continuing Healthcare: If the person has a primary health need — and end-of-life care almost always constitutes this — CHC can fund the entire cost, including the accommodation. This is worth pursuing even if a previous CHC application was rejected. The person's condition has changed, and the assessment should reflect that.

NHS-Funded Nursing Care (FNC): If CHC is not granted but the person receives nursing care, the NHS contributes £267.78 per week towards the fees. This applies automatically — the nursing home claims it directly.

Council means-tested funding: If assets are below £23,250, the council contributes. Below £14,250, the council pays in full.

Self-funding: If assets exceed £23,250, you pay the full nursing home fee — typically £1,000-£1,500 per week.

A Critical Edge for Self-Funders (The MSIF Benchmark): If you are told you must self-fund palliative nursing care, do not just accept the home's stated weekly fee. RightCareHome publishes the Market Sustainability and Improvement Fund (MSIF) data—the exact rates local councils pay these same homes. If a home quotes you £1,600/week (minus FNC), but the MSIF data shows your council pays them £1,150/week for the exact same palliative bed, you have strong leverage. You may not get the council rate, but knowing the true local benchmark helps you negotiate a fairer price.

What a nursing home should provide at end of life

A good nursing home with palliative expertise provides:

• Pain and symptom management by qualified nurses, 24 hours a day
• A private room (if the person does not already have one)
• Emotional and spiritual support, including chaplaincy if wanted
• Flexibility for family visits, including overnight stays
• Communication with the family about changes in condition
• Access to specialist palliative care teams if needed
• Anticipatory medications ("just in case" prescriptions) readily available

Not all nursing homes are equally experienced in end-of-life care. Staff training, staffing ratios overnight, and the home's relationship with local hospice services all matter.

Option 4: Care Home (Without Nursing)

End-of-life care in a residential care home (without nursing staff) is less common but possible when the decline is slow and the person's main needs are personal care, comfort, and companionship rather than clinical intervention.

The funding rules are the same as for standard residential care. District nurses visit for any nursing tasks. If nursing needs increase, the person may need to transfer to a nursing home.

For a full breakdown of care home funding options, see our guide.

The Critical Question: Does Your Parent Qualify for CHC?

NHS Continuing Healthcare is the single most impactful funding route at the end-of-life stage. If granted, it covers all care costs in any setting — home, nursing home, or hospice — with no means test.

Who qualifies

CHC is based on having a "primary health need." This means the person's care requirements are mainly due to a health condition rather than social care needs. End-of-life conditions — cancer, organ failure, advanced dementia, neurological disease — frequently meet this threshold.

Fast-track vs standard

What to do

1. Ask the GP whether fast-track CHC is appropriate. If they are unfamiliar with the process, the hospital discharge team or community nursing team can help.
2. If refused, you have the right to a full multidisciplinary assessment for standard CHC.
3. If standard CHC is refused, you can request an independent review.
4. Document everything — keep records of the person's care needs, nursing input, and any clinical assessments.

See our guide to appealing a CHC decision if you believe the refusal is wrong.

Charitable Support

Several charities provide direct support for families navigating palliative care.

Marie Curie — free nursing care at home (including overnight), a support line (0800 090 2309), and information on all aspects of end-of-life care.

Macmillan Cancer Support — grants of up to £350 for people with cancer (no repayment needed), specialist nurses, and benefits advice. Even if your parent's condition is not cancer, Macmillan's information resources cover palliative care broadly.

Sue Ryder — hospice care, home care, and bereavement support in several regions of England.

Turn2Us — a searchable database of charitable grants. Enter the person's condition, location, and circumstances to find grants they may be eligible for.

Carers UK — not palliative-specific, but their helpline (0808 808 7777) can guide family carers to local support services.

What to Do Next

If your parent or relative is approaching end of life and you are paying for care — or worried about how to fund it — take these steps:

1. Ask the GP about fast-track CHC. This is the single most important action. If eligible, care becomes free.
2. Contact the local hospice — even if inpatient care is not needed. Hospice-at-home and day hospice services can supplement whatever other care is in place.
3. Check Attendance Allowance — if not already claimed, it pays up to £114.60 per week and is not means-tested. Under the Special Rules for End of Life (prognosis of 12 months or less), applications are fast-tracked and paid at the highest rate automatically.
4. Review the council means test — particularly whether the property exemption applies.

For a personalised breakdown of every funding option based on your specific circumstances, our Funding Calculator covers CHC, council funding, Attendance Allowance, and benefits in one report.

If you need to find a nursing home with strong palliative care — whether for a planned transition or an urgent placement — the Calculator also matches you to homes based on 156 quality factors, including specialist end-of-life expertise and verified local MSIF data.

Get Your Custom Funding Action Plan

When to Request Fast-Track CHC

Ask the GP or hospital team about fast-track CHC if any of the following apply:

• The person has a rapidly deteriorating condition and a prognosis of weeks to months
• They have been discharged from hospital with end-of-life care needs that require funded support at home or in a nursing home
• Their care needs have increased significantly — for example, they now need 24-hour nursing or specialist symptom management
• A clinician has indicated the person is entering the final phase of life, even if a precise timeframe is uncertain

Fast-track decisions are typically made within 48 hours. If the GP is unsure of the process, the hospital discharge team or district nursing team can initiate the referral.

Sources

• NHS — NHS Continuing Healthcare
• NICE — End of Life Care for Adults (QS13)
• Marie Curie — Palliative Care and Funding Information
• Macmillan Cancer Support — Financial Help and Benefits
• GOV.UK — Attendance Allowance

Further Reading

• End of Life Care at Home: What to Expect, Who Pays, How to Arrange
• Do Dementia Patients Have to Pay Care Home Fees?
• NHS Continuing Healthcare for Dementia: Eligibility and How to Apply
• How to Appeal an NHS Continuing Healthcare Decision
• Care Home Funding Eligibility: A Complete UK Guide